New client intake · Loyal Loop Dog Training

First name *

Last name *

Email *

Phone *

Street address

City

State

ZIP

We work within 10 miles of Bloomington.

Emergency contact

Emergency phone

How did you hear about us?

Dog's name *

Breed (or best guess)

Sex

Birthdate (approx.)

Weight (lbs)

Spayed or neutered

Rabies vaccination expires

Required before any group class. We'll ask for a copy at the first session.

Veterinarian

Other health notes

This dog has bitten a person or another animal

If yes, what happened?

We are not here to judge. We need this to keep everyone, including your dog, safe.

Known triggers

What does success look like in 90 days? *

Previous training

Household

Food & motivation

Program you're interested in

When are you generally available?

I've read the training agreement, cancellation policy, and liability waiver and agree to them. *

You may use photos or video of my dog for training examples and social media.

Tell us about your dog